Unit 3: Models & Theories for health promotion

planning models

which are visual representations and descriptions of steps or phases in the planning process are the means by which structure and organization are given to the successful development and delivery of health promotion programs. models provide planners with direction and a framework from which to build interventions that can improve the health of individuals and communities

Generalized model

teaches basic principles of planning and evaluation emphasized in most planning models. a composite of what is represented in most, if not all other models.

5 elements of the generalized models

0.5. pre-planning
1. assessing needs
2. setting goals and objectives
3. developing interventions
4. implementing interventions
5. evaluating results

assessing needs

process of collecting and analyzing data to determine the health needs of a population can include priority setting and the identification of a priority populaiton

Setting goals and objectives

identifies what will be accomplished while interventions or programs are the means by which the goals and objectives will be achieved

implementation

is the process of putting interventions into action

evaluation

focuses on improving the quality of interventions (formative evaluation) as well as determining their effectiveness (summative evaluation)

PATCH (Planned Approach to Community Health)

mobilizes the community and is represented by what we have previously described as pre-planning.
Phase 1: mobilizing the community
phase 2: collecting and organizing data
phase 3: choosing health priorities and target groups
phase 4: choosing and conducting interventions
phase 5: evaluating the patch process and interventions

APEX-PH-Assessment Protocol for Excellence in Public Health

designed specifically for local health departments to engage in the planning and evaluation process
Phase 1: organizational capacity assessment
phase 2: the community process-- collection and analysis of community health status data, collection and analysis of community opinion data, development of an action plan with goals and objectives
phase 3: completing the cycle

MAPP (Mobilizing for Action through Planning and Partnerships)

- improving health and quality of life through mobilized partnerships and taking strategic action

phase 1: organizing for success and partnership development
phase 2: visioning
phase 3: four MAPP assessments
phase 4: identify strategic issues
phase 5: formulate goals and strategies
phase 6: action cycle

organizing for success and partnership development

core planners assess whether the MAPP process is timely, appropriate, or even possible.

visioning

guides the community through a process that results in a shared vision and common values

Four MAPP Assessments

community opinion, health department capabilities, health status, forces of change

identify strategic issues

a prioritized list of the most important issues facing the health of the community is developed

formulate goals and strategies

creates goals related to the vision and priority strategic issues it also selects and adopts strategies

action cycle

implementation details are considered, evaluation plans are developed, and plans for disseminating results are made.

MAP-IT (Mobilize, Assess, Plan, Implement, Track)

phase 1: mobilize
phase 2: assess
phase 3: plan
phase 4: implement
phase 5: track

mobilize

- starts by mobilizing key individuals and organizations into a coalition that can work together to improve the health of the community

assess

equivalent of a needs assessment

plan

involves developing goals and objectives, measures, baselines, and targets. planners will determine what will be measured

implement

involves organizing the coalition so it can put the plan into action

track

the equivalent of evaluation

two most significant challenges you will face in planning efforts

1. the preferences of stakeholders for a planning model or approach
2. interpersonal conflicts amoung stakeholders

benefits of generalized model

1. understanding principles related to program planning
2. helps you adapt and respond to complex planning tasks you will experience in professional practice
3. an increased ability to apply an important process closely related to program planning-- grant writing

community tool box

world's largest online resource for free information on essential skills for building healthy communities
-step-by-step guidance on specific community-building skills along with key tasks, examples, and support for developing and performing 16 core public health competencies

factors for selecting a specific planning model

1. the preferences of stakeholders
2. how much time and funding are available for planning purposes
3. how many resources are available for data collection and analysis
4. the degree to which clients are actually involved as partners in the planning process or the degree to which your planning efforts will be consumer oriented
5. preferences of a funding agency

three F's of program planning

1. Fluidity
2. Flexibility
3. Functionality

fluidity

suggests that steps in the planning process are sequential, or that they build on one another

flexibility

means that planning is adapted to the needs of stake holders. planning is usually modified as the process unfolds

Functionality

means that the outcome of planning is improved health conditions, not the production of a program plan itself

Population-based approach

planning processes used with large populations

Ecological Framework

recognizing that there are multiple levels of influence on behavior

PRECEDE-PROCEED

precede consists of a series of planned assessments that generate information that will be used to guide subsequent decisions. proceed is marked by the strategic implementation of multiple actions based on what was learned from the assessments in the initial phase
-led to think first inductively then seductively (start with desired ends and work back to original causes)
-obvious need for interdisciplinary work in field and multidisciplinary professionals
8 PHASES:
1. social assessment and situational analysis
2. epidemiological assessment
3. educational and ecological assessment
4. administrative and policy assessment and intervention alignment
V proceed
5. implementation
6. process evaluation
7. impact evaluation
8. outcome evaluation

social assessment and situational analysis

seeks to subjectively define the quality of life of those in the priority population while involving individuals in the priority population in an assessment of their own needs and aspirations
- social problems of community offer practical and often accurate barometer of its quality of life.
-indicators include: absenteeism, aesthetics, crime, unemployment, self-esteem

epidemiological assessment

-essential for program planning
-match info to contributing factors (phase 1) to main concerns/problems (phase 2)
- rank them in importance and reality
- consider vital indicators and their dimensions
-ID specific health-related behavior, environmental, and genetic factors that could be linked to health problem chosen in phase 2 (these are the risk factors that the intervention is going to be tailored to affect
- prioritization -- ranking and matrix (for narrowing)

vital indicators

morbidity, fertility, mortality, physiological risk factors, discomfort

dimensions

strength of problem/need: incidence and prevalence, longevity, intensity, functional level, and duration

incidence

new cases in a group in a certain time period

prevalence

existing cases in group at designated time period

environmental factors

are outside the person. and can be modified to support behavior health or quality of life. and we can be more realistic of limitation of program when we are cognitive of it. powerful social forces might be influcenced when the principles of proceed phases are translated into organizational strategies that are applied by groups in community

consider enviro, behav, and genetic indicators and dimensions

enviro: counseling servicesn(indicator) and accessibility (dimension)
behav: compliance (indicator) and frequency (dimension)
genetics: breastcancer (indicator:genetics predis) and poor diet (dimension:risk factor) interaction

Prioritization Matrix

look at diagram*

educational and ecological assessment

identifies and classifies the various factors that have the potential to influence a given behavior into three categories : pre-disposing, reinforcing, and enabling.
P, E, and R helps re prioritizing for intervention.
decision based on importance and evidence of possible change and costs.

pre-disposing factors

knowledge and many affective traits such as a persons attitude, values, beliefs, and perception. that facilitate or hinder our motivation for change
also include genetics, early childhood experiences that creat those values, beliefs and perceptions.

enabling factors

skills, resources, and barriers that help or hinder the desired behavior changes as well as environmental changes. can view them as vehicles or barriers. created by society forces or systems. can be ample or inadequate. can be supportive or restrictive.

reinforcing factors

different types of feedback and rewards that those in the priority population receive after behaviour change, which may either encourage or discourage the continuation of the behavior
- produce lifestyles which influence environment. through this political advocacy, consumer demand, and cumulative actions

Intervention alignment and administrative and policy assessment

the intent of intervention alignment is to match appropriate strategies and interventions with projected changes and outcomes identified in earlier phases. in administration and policy assessment, planners determine if the organizational and administrative capabilities and resources are available to develop and implement the program
- assess limitations (can include like resources, but also policies, abilities, and time)

Implemention

with appropriate resources in hand, planners select the interventions and strategies and implementation begins (make up the proceed portion)

Process, Impact and Outcome Evaluation

respectively and are based on the earlier phases of the model, when objectives were outlined in the assessment process. evaluation is integral and continuous throughout all phases of implementation (also proceed portions)

SMART

phase 1: preliminary planning
phase 2: consumer analysis
phase 3: market analysis
phase 4: channel analysis
phase 5: develop interventions, materials, and pretest
phase 6: implementation
phase 7: evaluation

preliminary planning

- identify a health problem and name it in terms of behavior
- develop general goals
- outline preliminary plans for evaluation
- project problem costs

consumer analysis

- segment and identify the priority population
- identify formative research methods
- identify consumer wants, needs, and preferences
- develop preliminary ideas for preferred interventions

market anaylsis

- establish and define the market mix
- assess the market to identify competitors, allies, and partners

channel analysis

- identify appropriate communication messages, strategies, and channels,
- assess options for program distribution
- identify communication roles for program partners
- determine how channels should be used

develop interventions, materials, and pretest

- develop program interventions and materials using information collected in consumer, market, and channel analyses
- interpret the marketing mix into a strategy that represents exchange and societal good
- pretest and refine the program

implementation

- communicate with partners and calrify involvement
- activate communication and distribution strategies
- document procedures and compare progress to time lines
- refine the program

evaluation 2

- assess the degree to which the priority population is receiving the program
- assess the immediate impact on the priority population and refine the program as necessary
- ensure that program delivery is consistent with established protocol
- analyze changes in the priority population

SWOT analysis (strengths, weaknesses, opportunities, threats)

it is an analysis of an organizations internal strengths and weaknesses, as well as opprotunities and threats in the operating environment. common among planners who want to minimize planning time and move quickly to action steps

challenges of SWOT

if consumer input is not received, problems are not analyzed thoroughly, relevant determinants are not addressed, or interventions are identified and implemented without adequately understanding the underlying theory or rationale.

health communities

community ownership and empowerment and driven by the values, and needs, and participation of community members with consultation from health profesionals

CHANGE tool (community health assessment and group evaluation)

assess community needs, action guides to assist in the development of interventions and strategies, and technical assistance with program evaluation

Health communication model

1) Planning & strategy development
2) Developing and pretesting concepts, messages & materials
3) Implementing the program
4) Assessing effectiveness & making refinement

planning and strategy development

assessing the health issue or problem and identifying potential solutions, defining communication objectives, defining potential audiences and learning about them, investigating appropriate settings

developing and pretesting concepts, messages, and materials

direct planners to review existing materials for appropriateness

implementing the program

draws positive attention to the campaign and related programs and interventions

assessing effectiveness and make refinements

involves refining the communication plan as immediate feedback is received through process evaluation and evaluating the effectiveness of the campaign in terms of changes in determinants and health status

intervention mapping

designed to fill a gap in health promotion practice by translating data collected.

1. Needs Assessment
2. Matrices
3. Theory Based Methods and Practical Applications
4. Program
5. Adoption and Implementation Plan
6. Evaluation Plan

needs assessment

is conducted by using the precede phases of the precede-proceed model and includes establishing a participatory planning groups, assessing community capacity, and linking the needs assessment to health outcomes and quality of life goals

matrices of change objectives

Specifies who and what will change as result of intervention

Theory Based Methods and Practical Applications

Guides the planner through a process of selected theory-based interventions and strategies

program production

describes the scope and sequence of the intervention, the completed program materiials, and program protocols

adoption and implementation

focus is on adoption and implementation of performance objectives

evaluation planning

planners decide if determinants were well specified, if strategies were appropriately matched to methods, what proportion of the priority population was reached, and whether or not implementation was complete and executed as planned

Health plan- it

strengthen in-country management training capacity in the health sector of developing countries
1. priority settings
2. establishing goals
3. outcome objectives
4. strategy
5. evaluation
6. budget

priority setting

involves participatory planning and consensus building, as well as priority setting, using the basic priority rating process.

establishing goals

follows the pattern outlined in previous models. goals are generalized statements of the result or achievement to which the planning effort is directed

outcome objectives

these are related to the program goals, usually long-term in nature, and are always measurable. also relate to the actual health problem

strategy

involves developing the methods or interventions that will be implemented to accomplish outcome objectives

evaluation and budget

identify ways to measure the success of outcome objectives as well as program impacts related to determinants and contributing factors

Theory

set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situation by specifying relations among variables in order to explain and predict the event of the situation. helps develop an organized, systematic, and efficient approach to investigating health behaviors

model

is a composite, a mixture of ideas or concepts taken from any number of theories and used together.

concepts

the primary elements or building blocks of a theory.

construct

when a concept has been developed, created, or adopted for use with a specific theory

variables

the operational form of a construct. specify how a construct is to be measured in a specific situation

theories as the backbone of the process used to plan, implement, and evaluate health promotion interventions

1. identifying why people behave as they do and why they are not behaving in healthy ways
2. identifying information needed before developing an intervention
3. providing a conceptual framework for selecting constructs to develop the intervention
4. providing direction and justification for program activities
5. providing insights into how best to deliver the intervention
6. identifying what needs to be measured to evaluate the impact of the intervention
7. helping to guide research identifying the determinants of health behavior

the "best theory"

is a function nof how well it serves the objectives that must be met to achieve sustainable protective behaviors among a specified population

types of theories and models

Planning models and behavior change theories

behavior change theories

help explain how change takes place.

socio-ecological approach

human behavior shapes and is shaped by multiple levels of influences

social context

the sociocultural forces that shape peoples day-to-day experiences and that directly and indirectly affect health and behavior

Five levels of influence

1. intrapersonal levels
2. interpersonal level
3. institutional or organizational factors
4. community factors
5. public policy factors
6. physical environment
7. culture

intrapersonal level

individual characteristics that influence behavior, such as knowledge, attitudes, beliefs, and personality traits

interpersonal level

interpersonal processes and primary groups, including family, friends, and peers that provide social identity, support, and role definition

institutional factors

Rules, regulations, policies, and informal structures, which may constrain or promote recommended behaviors

public policy

local, state, and federal policies and laws that regulate or support healthy actions and practices for disease prevention, early detection, control, and management

physical environment

natural and built environment

culture

shared beliefs, values, behaviors and practices of a population

continuum theories

those behavior change theories that identify variables that influence actions (i.e. beliefs, attitudes) and combine them into a single equation that predicts the likelihood of action.

stage thoery

on that is comprised of an ordered set of categories into which people can be classified and which identifies factors that could induce movement from one category to the next.

stage theories 4 principles

1. category system to define the stages
2. an ordering of stages
3. common barriers to change facing people in the same stage
4. different barriers to change facing people in different stages